Module in Growth and Development PDF

Manila Adventist College 1975 cor. San Juan and Donada Sts., Pasay City 1300 School of Nursing NCM 107: Care of Mother, Child, Adolescent (Well Clients) Nursing Module Introduction:...

Manila Adventist College 1975 cor. San Juan and Donada Sts., Pasay City 1300 School of Nursing NCM 107: Care of Mother, Child, Adolescent (Well Clients) Nursing Module Introduction: This course deals with concepts, principles, theories, and techniques in the nursing care of individuals and families during childbearing and childrearing years toward health promotion, disease prevention, restoration and maintenance, and rehabilitation. The learners are expected to provide safe, appropriate and holistic nursing care to clients utilizing the nursing process. Topic/ Concept : Growth and Development Learning Objectives: After completing this module in Growth and Development, the students will be able to: 1. Describe a normal infant, toddler, preschooler, schoolage and adolescent growth and development and associated parental concerns. 2. Describe the principles of growth and developmental stages according to major theorists. 3. Identify the developmental milestone in each stage of growth and development. 4. Assess a child to determine whether a developmental stage has been achieved. 5. Formulate nursing diagnosis that will address wellness as well as both a potential for an actual delay in growth and development 6. Implement nursing care that will promote growth and development. 7. Evaluate the growth and development across the lifespan. Normal Pediatric Nursing The Consumers of Pediatric Care Neonate Infant Toddler Pre-schooler Schooler Adolescents Nursing Process Approach Age-Group: Generalities Assessment: Normal Growth and Development, Head-to-toe assessment Diagnosis: Common Problems Implementation of nursing measures to address common problems Summary of the Age-group GENERAL PRINCIPLES Definition of Terms A. Growth: increase in size of a structure. Human growth is orderly and predictable, but not even; it follows a cyclical pattern. B. Development: maturation of physiologic and psychosocial systems to more complex state. C. Cephalocaudal: head-to-toe progression of growth and development Development proceeds from head down to the toes Infants achieve control of the head before the trunk D. Proximodistal: trunk-to-periphery (fingers and toes) progression of growth and development Development proceeds from the midline of the body to the extremities  Growth and development are continuous processes from conception until death. Growth and development proceed in an orderly sequence. Different children pass through the predictable stage at different rates. All body systems do not develop at the same rate Development is cephalocaudal Development proceeds from proximal to distal body parts. Development proceeds from gross to refined skills. There is an optimum time for initiation of experiences or learning. Neonatal reflexes must be lost before development can proceed. A great deal of skill and behavior is learned by practice. Rates of Development A. Fetal period and infancy: the head and neurologic tissue grow faster than other tissues. B. Infancy and adolescence: fast growth periods C. Toddler through school-age: slow growth periods D. Toddler and preschool periods: the trunk grows more rapidly than other tissue. E. The limbs grow most during school-age period. F. The trunk grows faster than other tissue during adolescence. Stages of growth and development 1. Pre-natal period 2. Neonate- birth 28 days 3. Infancy- One month to 12 months 4. Toddler- 1 year to 3 years 5. Pre-school- 3 years to 6 years 6. School-aged- 6 years to 12 years 7. Adolescence- 12 years to 18 years The Personality Development Theories 1. Psychosexual theory- Psychoanalytical theory 2. Psychosocial theory 3. Cognitive theory 4. Interpersonal theory 5. Moral development theory Five Stages of psychosexual development 1. Oral 2. Anal 3. Phallic or Oedipal 4. Latency 5. Genital Freud proposes that the underlying motivation to human development is an energy form or life instinct called LIBIDO. Unconscious mind is the mental life of a person of which the person is unaware. Proposed concepts like: ID, EGO, SUPER EGO ID developed during infancy "I know what I want and I want it now!” Pleasure principle EGO developed during toddler period "I can wait for what I want!" Reality principle balances the id and superego SUPEREGO developed during preschool period "I should not want that!” Conscience- Morality principle 1. Oral a. 0-12 months b. Pleasure and gratification through mouth c. Behaviors: dependency, eating, crying, biting d. Distinguishes between self and mother e. Develops body image, aggressive drives 2. Anal a. 1 year - 3 years b. Pleasure through elimination or retention of feces c. Behaviors: control of holding on or letting go d. Develops concept of power, punishment, ambivalence, concern with cleanliness or being dirty 3. Phallic/Oedipal a. 3 - 6 years b. Pleasure through genitals c. Behaviors: touching of genitals, erotic attachment to parent of opposite sex d. Develops fear of punishment by parent of same sex, guilt, sexual identity  4. Latency a. 6 - 12 years b. Energy used to gain new skills in social relationships and knowledge c. Behaviors: sense of industry and mastery d. Learns control over aggressive, destructive impulses e Acquires friends 5. Genital a. 12 - 20 years b. Sexual pleasure through genitals c. Behaviors: becomes independent of parents, responsible for self d. Develops sexual identity, ability to love and work Erikson’s Psychosocial theory Trust versus mistrust Autonomy versus shame and doubt Initiative versus guilt Industry versus inferiority Identity versus role confusion Intimacy versus isolation Generativity versus stagnation Ego integrity versus despair Psychosocial Model (Erikson) 1. Trust vs mistrust a. 0 - 18 months b. Learn to trust others and self vs withdrawal, estrangement 2. Autonomy vs shame and doubt a. 18 months - 3 years b. Learn self-control and the degree to which one has control over the environment vs compulsive compliance or defiance 3. Initiative vs guilt a. 3 - 5 years b. Learn to influence environment, evaluate own behavior vs fear of doing wrong, lack of self-confidence, overrestricting actions 4. Industry vs inferiority a. 6 - 12 years b. Creative; develop sense of competency vs sense of inadequacy Psychosocial Model (Erikson) 5. Identity vs role confusion a. 12 - 20 years b. Develop sense of self; preparation, planning for adult roles vs doubts relating to sexual identity, occupational career 6. Intimacy vs isolation  a. 18 - 25 years b. Develop intimate relationship with another; commitment to career vs avoidance of choices in relationships, work, or life-style 7. Generativity vs stagnation a. 21 - 45 years b. Productive; use of energies to guide next generation vs lack of interests, concern with own needs 8. Integrity vs despair a. 45 years to end of life b. Relationships extended, belief that own life has been worthwhile vs lack of meaning of one’s life, fear of death PIAGET – COGNITIVE THEORY Sensori-motor (birth to 2 ) Pre-operational (2-7) Preoperational preconceptual (2-4) Preoperational intuitive (4-7) Concrete operational (7-12) Formal operational (12 to adulthood) A. 0 - 2 years: sensorimotor -reflexes, repetition of acts B. 2 - 4 years: preoperational/preconceptual -no cause and effect reasoning; egocentrism; use of symbols; magical thinking C. 4 - 7 years: intuitive/preoperational -beginning of causation Cognitive Theory (Piaget) D. 7 – 12 years: concrete operations - uses memory to learn - aware of reversibility E. 12 - 15 years: formal operations -reality, abstract thought -can deal with the past, present and future INTERPERSONAL THEORY (SULLIVAN) This concept focuses on interaction between an individual and his environment Personality is shaped through “interaction” with significant others We internalize approval or disapproval from our parents Personality has three SELF-SYSTEM 1. “Good Me” develops in response to behaviors receiving approval by parents/SO 2. “Bad Me” develops in response to behaviors receiving disapproval by parents/SO 3. “Not Me” develops in response to behaviors generating extreme anxiety in parents/SO and this is denied as part of oneself INTERPERSONAL MODEL (SULLIVAN) 1. Infancy a. 0 - 18 months b. Others (Caregivers) will satisfy needs 2. Childhood a. 18 months - 6 years b. Learn to delay need gratification 3. Juvenile a. 6 - 9 years b. Learn to relate to peers 4. Preadolescence a. 9—12 years b. Learn to relate to friends of same sex 5. Early adolescence a. 12—14 years b. Learn independence and how to relate to opposite sex 6. Late adolescence a. 14—21 years b. Develop intimate relationship with person of opposite sex KOHLBERG’S STAGES OF MORAL DEVELOPMENT Moral Theory 1. Pre-Conventional Stage 1: Age group: 2 – 3 years Description of morality: Punishment or obedience (heteronomous morality) A child does the right things because a parent tells him or her to avoid punishment Child is UNABLE to understand other’s viewpoint Stage 2: Age group 4 – 7 years Description of morality: Individualism- Hedonism  Child carries out actions to satisfy own needs rather than society’s. The child does something for another if that person does something for him in return- “an eye for an eye’ 2. Conventional Level Stage 3: Age Group : 7-10 years Description of morality: Orientation to interpersonal relations of mutuality- CONFORMITY A child follows rules because of a need to be a good person in own eyes and in the eyes of others “Good boy or Good girl” Stage 4 : Age Group : 10-12 years Description of morality: Maintenance of social order, fixed rules and authority Child FOLLOWS RULES of authority figures as well as parents to keep the system working LAW and ORDER 3. POST Conventional Stage 5: Age Group : 12 and above Description of morality: social contract, utilitarian law making perspective child FOLLOWS STANDARDS OF SOCIETY for the good of all people Stage 6; Age Group: older than 12 Descriptions: universal ethical principle orientation Respect and dignity of humanity FOWLER’S SPIRITUAL DEVELOPMENT Death Concepts (Kozier) Infancy – 3 years: No clear concept of death. 3 – 4 years: it is reversible, temporary sleep 5 – 9 years: understands death is final but can be avoided 9 – 12: Death is inevitable, everyone will die someday 12 – 18: Fears a lingering ddeath  18 – 45: Attitude is influenced by religion 45 – 65: experiences peak of death anxiety 65 and above: death as multiple meanings Child’s Response to Death 1. Infants and toddlers - toddlers may insist on seeing a significant other long after that person’s death. 2. Preschoolers - may see death as temporary; a type of sleep or separation. 3. School-age – See death as a period of immobility. - Feel death is punishment. 4. Adolescents - Have an accurate understanding of death. NEONATE (Birth - 1 month) Motor development 1) behavior is reflex controlled 2) flexed extremities A. Physical tasks Sensory development 1) hearing and touch well developed at birth 2) sight not fully developed until 6 years a) differentiates light and dark at birth b) rapidly develops clarity of vision within 1 foot c) fixates on moving objects d) strabismus due to lack of binocular vision B. Psychosocial tasks a. Cries to express displeasure b. Smiles indiscriminately c. Receives gratification through sucking d. Makes throaty sounds C. Cognitive tasks Neonatal period: reflexive behavior only INFANT : 1 – 4 months A. Physical tasks : 1 - 4 months Head growth: posterior fontanel closes Motor development 1) reflexes begin to fade (e.g., Moro, tonic neck) 2) gains head control→ 3 months 3) rolls from back to side→ 4 months 4) begins voluntary hand-to-mouth activity  Sensory development (1-4 months) 1) begins to be able to coordinate stimuli from various sense organs 2) hearing: locates sounds by turning head and visually searching 3) vision: follows objects 180° Language development (1-4 months) 1) Crying and gurgling sounds→ 1 month 2) Makes cooing sounds→ 2 months 3) Laughs and Squeals→ 3-4 months Social development ( 1-4 months) 1) Crying and gurgling sounds→ 1 month 2) Makes cooing sounds→ 2 months 3) Laughs and Squeals→ 3-4 months B. Psychosocial tasks ( 1 – 4 months) a. Crying becomes differentiated at 1 month 1) decreases during awake periods 2) ceases when parent in view b. Vocalization distinct from crying at 1 month 1) coos, babbles, laughs; vocalizes when smiling c. Socialization 1) stares at parents’ faces when talking at 1 month 2) smiles socially at 2 months 3) shows excitement when happy at 4 months 4) demands attention, enjoys social interaction with people at 4 months C. Cognitive tasks ( 1 – 4 months) a. Recognizes familiar faces b. Is interested in surroundings c. Discovers own body parts 5 - 6 months A. Physical Tasks: Weight: birth weight doubles; gains 3-5 oz (84-140 g) weekly for next 6 months Length: gains 1/2 inch (1.25 cm) for next 6 months Eruption of teeth begins 1) lower incisors first 2) causes increased saliva and drooling  3) enzyme released with teething causes mild diarrhea, facial skin irritation 4) slight fever may be associated with teething, but not a high fever or seizures Motor development 1) supports weight on arms 2) sits with support Sensory development 1) hearing: can localize sounds above and below ear 2) vision: smiles at own mirror image and responds to facial expressions Others. 3) taste: sucking needs have decreased and cup weaning can begin; chewing, biting, and taste preferences begin to develop B. Psychosocial tasks 5 - 6 months a. Vocalization: begins to imitate sounds b. Socialization: recognizes parents, stranger anxiety begins to develop; comfort habits begin C. Cognitive tasks 5 - 6 months a. Begins to imitate b. Can find partially hidden objects 7 – 9 months A. Physical tasks a. Teething continues 1) 7 months: upper central incisors 2) 9 months: upper lateral incisors b. Motor development 1) Crawls → 8 to 9 months may go backwards initially 2) pulls self to standing position 3) develops finger-thumb opposition (pincer grasp) B. Psychosocial tasks a. Vocalization: verbalizes all vowels and most consonants b. Socialization 1) shows increased stranger anxiety and anxiety over separation from parent 2) exhibits aggressiveness by biting at times 3) understands the word “no”  C. Cognitive tasks a. Begins to understand object permanence; searches for dropped objects b. Reacts to adult anger; cries when scolded c. Imitates simple acts and noises d. Responds to simple commands 10-12 months a. Weight: birth weight tripled b. Length: 50% increase over birth length c. Head and chest circumference equal d.Teething 1) lower lateral incisors erupt 2) average of six to eight deciduous teeth A. Physical tasks 1) walks with help or cruises (10 months) 2) may attempt to stand alone B. Psychosocial tasks a. Vocalization: imitates animal sounds, can say only 4 - 5 words but understands many more (ma, da) b. Socialization 1) begins to explore surroundings 2) plays games such as pat-a-cake, peek-a-boo 3) shows emotions such as jealousy, affection, anger, fear (especially in new situations) C. Cognitive tasks a. Recognizes objects by name b. Looks at and follow pictures in book c. Shows more goal-directed actions NUTRITION Birth to 6 months a. Breast milk is a complete and healthful diet; supplementation may include 0.25 mg fluoride, 400 IU vitamin D, and iron after 4 months. b. Commercial iron-fortified formula is acceptable alternative; supplementation may include 0.25 mg fluoride if water supply is not fluoridated.  c. Juices may be introduced at 5-6 months, diluted 1:1 and preferably given by cup. 6 - 12 months a. Breast milk or formula continues to be primary source of nutrition. b. Introduction of solid foods starts with cereal (usually rice cereal), which is continued until 18 months. Cereal → fruits → vegetables→ meat→ egg yolk c. Introduction of other food is arbitrary; most common sequence is fruits, vegetables, meats. 1) introduce one new food a week. 2) decrease amount of formula to about 30 oz. as foods are added. d. Iron supplementation can be stopped. 6 - 12 months e. Finger foods such as cheese, meat, carrots can be started around 9-10 months. f. Chopped table food or junior food can be introduced by 12 months g. Weaning from breast or bottle to cup should be gradual during second 6 months. Infant PLAY (Solitary) Birth to 4 months a. Provide variety of brightly colored objects, different sizes and textures. b. Hang mobiles within 8-10 inches of infant’s face. 5 - 7 months a. Provide brightly colored toys to hold and squeeze. b. Allow infant to splash in bath. c. Provide crib mirror. 8 - 12 months a. Provide toys with movable parts and noisemakers; stack toys, blocks; pots, pans, drums to bang on; walker and push-pull toys. b. Plays games: hide and seek, pat-a-cake. FEARS 1. Separation from parents a. Searches for parents with eyes. b. Shows preference for parents. c. Develops stranger anxiety around 6 months, peak at 8 months 2. Pain  a. hold and comfort infant b. reduce painful procedures if possible PROMOTING SENSORY STIMULATION VISION Teach parents to make eye-to-eye contact with the infant to stimulate vision and to promote socialization. Infants enjoy mobiles and crib mirror Photos of family members may be posted near the baby's crib. HEARING Infant's toys should have soft, musical or cooing sounds. An audiotape of family voices might be soothing reminder of their presence when they are not around. TOUCH Clothes should feel comfortable and diaper should always be dry. Teach parents to handle the infant with assurance and with gentleness. “Kangaroo hold" promotes close physical contact. TASTE Infants turn away or spit out a taste they do not enjoy. Urge parents to make a mealtime for fostering trust as well as supplying nutrition. Feedings should be at the infant's pace and the amount should fit the child's needs New foods should be introduced one at a time so that the child can become accustomed to one new taste before another is tried. This also lets parents detect adverse reactions, such as allergy to a new food. SMELL Infants smell accurately within 1-2 hours after birth. Infants draws back from irritating smell and enjoys pleasant odors like that of the breast milk teach parents to be alert to substances that cause sneezing when sprayed into the air INFANT’S DAILY ACTIVITIES BATHING Bath serves many functions: a. to promote cleanliness.  b. to provide opportunity for the baby to exercise c. to give parents time to talk, touch and communicate with the baby. d. to give the baby the opportunity to learn different textures and sensations. DIAPER – AREA CARE Good diaper-area hygiene means not to allow an infant to wear soiled diapers for a lengthy time. Diapers should be changed frequently. Skin should be washed thoroughly with water and mild soap. CARE OF THE TEETH Fluoride is important in proper tooth development and prevention of tooth decay. Teach parents to begin "brushing" even before teeth erupt by rubbing a piece of gauze over the gum pads. Toothpaste may not be necessary. DRESSING Clothes should be easy to launder and simply constructed Type of clothing should suit infant’s activity level SLEEP Infants need 10-12 hours of sleep a night and one or several naps during the day. Caution parents not to place pillows to avoid possibility of suffocation. EXERCISE The infant benefits from outings in a carriage or stroller, as sunlight provides a natural source of vitamin D. Early mornings and late afternoons are the best times for the infant to be outside. PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY 1. Teething→ use of cool teething rings 2. Thumb sucking→ reassure parents, provide sucking pleasures 3. Use of Pacifiers→ ensure cleanliness 4. Head Banging→ pad rails and reassure parents PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY 5. Sleep Problems→ provide soft toys and music 6. Constipation→ increase fluid intake and fiber 7. Loose Stools→ assess and intervene 8. Colic→ assess, burp, make feeding stimulating PARENTAL CONCERNS AND PROBLEMS RELATED TO INFANCY 9. Spitting up → upright position feeding, burp baby, bib during feeding 10. Diaper Dermatitis→ frequent change, air dry 11. Miliaria→ bathing with baking soda 12. Baby bottle syndrome →avoid bottle during sleep IMMUNIZATION BCG Hepa B BREAST FEEDING ADVANTAGE Readily available Economical Promotes facial muscles, jaw and teeth Mother infant bonding Reduced incidence of allergies Reduced incidence of maternal breast cancer Transfer of maternal antibodies BREAST FEEDING DISADVANTAGES Prevents other from feeding the infant Limits paternal role in feeding Compels the mother to monitor her diet carefully Maybe difficult to a working mother Digest quickly → more feeding BREAST FEEDING ADEQUATE feeding? Wets 6 to 8 diapers a day Gaining weight Sleeps well BOTTLE FEEDING ADVANTAGE Permits the father to feed Mother → can take medications Fewer feedings Feeding → public → little embarrassment BOTTLE FEEDING DISADVANTAGES Cost Greater preparation and effort Hands → should be clean Requires refrigeration and storage  No transfer of maternal antibodies Doesn’t benefit mother physiologically SUMMARIZING THE INFANT 1 MONTH TO 1 YEAR Double weight at 6, triple weight at 12 months First tooth at 6 months GROSS: lift chest at 2, sits at 6-8, creeps at 9, cruise at 10, walks after 12 FINE: transfers object at 7, pincer grasp at 9-10 LANGUAGE: Cries at 2, “Mama-Dada” at 9 VISION: Past midline at 3, focus object at 6 PLAY: Solitary, toy: mobile, rattles, mirror Theory: Oral, Id, Trust vs Mistrust, Sensori-motor INFANCY (0 to 1 yr) I – ron supplement (4 to 6 months), Immunization N – o choking hazard F – ear of stranger peaks at 8 months A – llow to use a pacifier if NPO N – ote the weight changes T – rust V.S. mistrust S – olitary play TODDLER (12 MONTHS TO 3 YEARS) Physical tasks: this is a period of slow growth 1. Weight: gain of approximately 11 lb (2.5 to 5 kg) during this time; birth weight quadrupled by 2 1/2 years 2. Height: grows 20.3 cm (8 inches) 3. Head circumference: 19½ - 20 inches (49 - 50 cm) by 2 years Anterior fontanel closes by 12-18 months Weight gain pattern 2x → 6 months 3x → 1 year 4x → 2 ½ year Developmental Milestones: Gross 15 months→ walks alone well 18 months→ walks upstairs, runs 21 months→ walks upstairs and downstairs, runs well 2 years → runs, walks up and down, jumps 3 years→ rides TRIcycle, balance on one foot briefly Developmental Milestones: fine 15 months→ drinks from a cup  18 months→ scribbles spontaneously 21 months→ imitates vertical line 2 years → imitates a circle at 2 1/2 3 years→ wiggles thumb Toddler (12 months to 3 years) Developmental Milestones: language 15 months→ 18 months→ uses ONE word in a sentence (usually three words other than mama or dada) 21 months→ 2 years → uses TWO words in a sentence 3 years→ uses THREE words in a sentence Vitals Pulse 110; respirations 26; blood pressure 99/64 Dentition Primary dentition (20 teeth) completed by 2 1/2 years Control Develops sphincter control necessary for bowel and bladder control Psychosocial tasks 1. Increases independence; better able to tolerate separation from primary caregiver. 2. Less likely to fear strangers. 3. Able to help with dressing/undressing at 18 months; dresses self at 24 months. 4. Has sustained attention span. 5. May have temper tantrums during this period; should decrease by 21/2 years. 6. Vocabulary increases from about 10 - 20 words to over 900 words by 3 years. 7. Has beginning awareness of ownership (my, mine) at 18 months; shows proper use of pronouns (I, me, you) by 3 years. 8. Moves from hoarding and possessiveness at 18 months to sharing with peers by 3 years. 9. Toilet training usually completed by 3 years. a. 18 months: bowel control b. 2 - 3 years: daytime bladder control c. 3 - 4 years: nighttime bladder control Cognitive tasks 1. Follows simple directions by 2 years. 2. Begins to use short sentences at 18 months to 2 years. 3. Can remember and repeat 3 numbers by 3 years.  4. Knows own name by 12 months; refers to self, gives first name by 24 months; gives full name by 3 years. 5. Able to identify geometric forms by 18 months. 6. Achieves object permanence; is aware that objects exist even if not in view. 7. Uses “magical” thinking; believes own feelings affect events (e.g., anger causes rain). 8. Uses ritualistic behavior; repeats skills to master them and to decrease anxiety. 9. May develop dependency on “transitional object” such as blanket or stuffed animal. Sense of Autonomy Favorite word: “NO” Child learns to be independent Understanding love of the child is shown by: giving him all the freedom he can safely use giving him all the love and help he needs to keep him safe in an environment beyond his control giving in which he feels himself to be focal point Negativism Gives the child opportunity to make choices Regulating the toddler’s activities which is an important part of his training is a challenge to the adult Providing safe environment for a gradually expanding area of growth Avoiding use of pain and ridicule as a means of punishment or of prevention of forbidden activities Allowing the child to have certain amount of defiance, which is normal Toilet Training The child must begin accepting the “reality principle” (giving up an immediate pleasure in order to gain another pleasure later.) Toddler must give up the pleasure of excreting where and when he wishes in order to gain his mother ‘s approval. Requisites for Toilet Training 1. Physiologic readiness Sphincter control – myelination of nerve tract occurs at around 15 – 18 months of age (MOST IMPORTANT REQUIREMENTS) Recognizes the urge and with ability to stand and walk to the bathroom and manage clothing 2. Psychological readiness Understands the act of elimination  Ability to verbally communicate need to defecate or urinate Mother or caretaker must be able to recognize verbal behavior Schedule/Timing of Training 15 – 18 months: start of training 18 – 24 months: bowel control 2 – 3 years: daytime bladder control 3 – 4 years : night time bladder control Principles of Toilet of Training Bowel training should be started before bladder training. Bladder training is done 1 or more months after fairly well established bowel training. Training should not be accomplished during illness. Consistency – observe usual time for defecation Firm but not strict training should be done (